Individual
MISS JACQUELYN S COREIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2273 W GENESEE RD, BALDWINSVILLE, NY 13027-9674
(315) 572-5520
Mailing address
2273 W GENESEE RD, BALDWINSVILLE, NY 13027
(315) 572-5520
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
235781-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
235781-1
LPN LICENSE
NY
Enumeration date
04/21/2016
Last updated
04/21/2016
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